The new heart disease guideline everyone over age 40 needs to know about

You’ve heard me rail against the U.S. Preventive Services Task Force (USPSTF) before. That’s because I can’t think of a single thing they’ve actually prevented with their terrible advice. Like when they proclaimed there’s no reason for doctors to counsel patients about healthy lifestyle choices for cardiovascular disease (CVD) prevention.

Now who do you think advice like that benefits? It’s certainly not you, the patient. The pharmaceutical companies, on the other hand, benefit when your health gets so bad your doctor puts you on prescription drugs. And even your doctor benefits, because he or she can use the time they’re NOT spending with you to discussing natural disease prevention to see (and bill) more patients.

And now, thanks once again to the USPSTF, they have even LESS incentive to discuss safe, natural ways to keep your heart healthy. That’s because on November 13, the USPSTF released new guidelines for primary prevention of CVD — and they named statins as a first-line defense for just about everyone.

For adults ages 40 to 75 without a history of CVD who have one or more risk factors (high cholesterol or blood pressure, diabetes, or smoking) and who have a 10 percent or greater risk of having a heart attack or stroke in the next 10 years, the USPSTF recommends using low to moderate doses of statins.

But for people in that same demographic, with the same risk factors, who have only a 7.5 percent to 10 percent chance of having a heart attack or stroke in the next 10 years, the task force recommends statins be offered “selectively,” taking into account professional judgment and patient preferences.

So basically, they’re expecting physicians to be able to determine — within 2.5 percentage points — what each patient’s risk is for heart attack or stroke. And then their choices are either a) prescribe statins or b) decide whether to prescribe statins.

This is deeply problematic for a number of reasons.

First of all, I guarantee the majority of physicians have no idea how to accurately predict 10-year CVD risk, let alone down to a specific percentage.

And second, they’re basically signing off on across-the-board statin use for people with zero CVD history just because they have diabetes, are smokers, or have cholesterol or blood pressure above what’s considered “normal.”

And let’s not forget that those “normal” levels are controversial to begin with. They’re determined by panels of “experts” — many of whom have direct ties to the companies that produce blood pressure and cholesterol medications.

The one moment of clarity the task force seemed to have was when it said there’s insufficient evidence about the benefits and harms of starting statins in people over age 75. Although I can’t tell you how many of my patients at this age (and above) are constantly hounded by their other doctors about taking these drugs.

But in their defense, the task force did bring up the debate about statins for CVD prevention. And they did emphasize persisting gaps in the literature.

As a result of these gaps, there are now four different sets of major recommendations on statins. That’s mind-boggling to clinicians, let alone patients. The guidelines differ on when to treat high cholesterol, what ideal levels of LDL cholesterol should be, and more.

Which just points to how unreliable all these different sets of guidelines are. And this new one is no different.

The fact of the matter is that there is NO good evidence supporting statin use in people with no symptoms or markers of CVD. (For that matter, there’s no good evidence supporting statin use for anything other than lowering cholesterol. Which is an unreliable marker of heart risk to begin with.)

And let’s not forget about the evidence regarding possible harms of statins.

Statins can — and often do — have significant effects on quality of life, such as muscle pain, weakness, cognitive dysfunction, and even diabetes. That’s right, statins may cause one of the conditions that will land you on the “must-take-statins” list. And the vicious cycle continues.

I also think it’s worth mentioning that all the trials the USPSTF included in its evidence review to establish this new guideline — with the exception of one — were sponsored by the pharmaceutical industry. So clearly we’re looking at biased findings here.

When the industry that stands to profit from increased prescriptions is in charge of determining who gets prescriptions, we all lose.

Which is just one of the reasons why the use of statins for primary prevention is malpractice, if you ask me.

If doctors really want guidelines that put the public, and not Big Pharma, front and center, here they are: Promote a heart-healthy diet, regular physical activity, and not smoking. It’s a no-brainer. It costs no money and is the only thing shown to work in the long term…without doing any harm.